Telephone: (include area code)
Boat description ( houseboat,
sportfisherman, etc.)
Power, sail, outboard, inboard
Hull color:
Trim color:
State/Registration number:
Length in feet:
Boat name:
Make/Model/Year:
Persons aboard (count yourself)
Name, age,address, telephone of each
passenger aboard
Engine info:
(Gasoline, diesel- Inboard/Outboard-Horse
power- Number of engines)
Fuel capacity in gallons:
Survival equipment (Check ):
Frequencies or channels used
Call sign/number:
Trip Plans
Leaving from:
Going to:
Leaving (Date)
Leaving (Time)
Return by (Date)
Return by (Time)
But no later than (Date)
But no later than (Time)
Other Information:
Vehicle Ashore
Make/Model/Year:
Color(s):
State/License number:
Trailer state/License number:
Where parked:
If not returned by
Date and Time
CALL
Coast Guard Tel #
or, Local Authority (Name) Tel #
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